Mental health trusts are the perfect partner for PCT provider arms

Primary care trusts had two choices for the future of their provider arms under Transforming Community Services, as of 1 April: to set them up in their own right as a social enterprise or aspiring community foundation trust; or to transfer their management to another provider.

While many transferred services have ended up in an acute environment, some PCTs have decided that their provider services would be better off paired with mental health services.

A third of mergers and acquisitions of PCT provider arms considered by the Cooperation and Competition Panel, which reviews proposed mergers to ensure that they are in the best interests of patients and taxpayers, have been with mental health trusts.

The panel has agreed 126 acquisitions of PCT provider arms: 66 have been acquired by acute trusts, 43 by mental health trusts and 17 by other community service providers.

Steve Shrubb, director of the Mental Health Network at the NHS Confederation, says the decision to combine community and mental health services within one organisation is a good one because there is a lot of synergy between the two types of services, which not only benefits patient care but creates efficiencies.

“If you start from the perspective of the organisations, mental health providers have for the last hundred years been closing hospitals and moving from institutional care to community care services,” he explains. “The way the staff work and the way the staff think - that they are part of the community, they are working in the community, they are working with communities - is actually very similar.”

Moving forward

This presents exciting opportunities to bring district nursing, health visiting and community services together with mental health services to create much better joined up care pathways for the benefit of patients and to create efficiencies.

“Instead of being visited several times by different people you get a single much more focused delivery of services,” he says. “There’s a lot talked about holistic care - bringing together physical and mental healthcare - and this is an opportunity to move that forward in a practical way.”

Older people, particularly those with dementia, will benefit, but the links between physical and mental health cross the whole range of patient ages and conditions.

For example, 66 per cent of mental health problems start by the time people are young adults and young mothers are the mothers most likely to have mental health problems after giving birth. Bringing together child and adolescent services and health visiting to create more integrated pathways can provide earlier and better support for such patients.

More integrated pathways between community and mental health services also creates opportunities to more immediately meet the mental health needs of people with long term conditions, such as diabetes and rheumatoid arthritis, and help them get better faster and stay better.

As well as advantages for patients, practical efficiencies can be made from having two types of community services through the same organisation, Mr Shrubb says.

“The nice thing about this debate is that QIPP [the quality, innovation, productivity and prevention programme] is about quality as well as efficiencies and it delivers both.

“I’m not saying there are no opportunities in putting them in acute trusts, there obviously are, but there are very many advantages in creating new organisations by bringing them in together with mental health organisations.”

At the beginning of the month, Coventry Community Health Services, NHS Coventry’s provider arm, transferred around 1,200 full time staff and £60m worth of activity to mental health trust Coventry and Warwickshire Partnership Trust.

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Approved acquisitions of provider arms by mental health trusts

Coventry and Warwickshire Partnership Trust chief executive Rachel Newson says: “We already have expertise in delivering community based services, as we see significantly more people in the community than we do in our inpatient services.

“We aim to develop integrated models of service to address the health and wellbeing of local people and, wherever possible, avoid the need for hospital admission.

“We will benefit from the skills and experience coming into our organisations.”

In some areas, such as Wolverhampton and Rotherham, PCT provider arms have been split up, with some services going to acute trusts, others to mental health trusts and some setting up as social enterprises and integrating with other organisations.

Mr Shrubb says: “When it works best is where people look for real connections; you don’t just do it for the sake of doing it, you say that service fits better in that organisation and that one fits better in another.”

Best local fit

Wolverhampton City PCT chief executive Jon Crockett says: “The PCT undertook an extensive evaluation with local stakeholders to ensure the best fit for local services. This work was based on care pathways and how best to improve services, and the overwhelming views were that services should stay with local NHS providers. The exercise also identified that mental health services would benefit from being part of a specialist mental health organisation, building on our existing partnership arrangements with Sandwell Mental Health and Social Care Foundation Trust.”

As a result, as of 1 April community services, such as district nursing, health visiting and physiotherapy, and one of the city’s two walk-in centres, were transferred to the Royal Wolverhampton Hospitals Trust, while the management of mental health, addiction and learning disabilities services became the responsibility of Sandwell Mental Health and Social Care Foundation Trust.

In Rotherham services have been split between a new social enterprise, Rotherham Foundation Trust, Rotherham Hospice Trust and mental health provider Rotherham, Doncaster and South Humber Foundation Trust. NHS Rotherham chief executive Andy Buck says services had been transferred to the local providers with the expertise to ensure that patients continued to receive the best possible treatment and care.

“Patients will not notice any immediate changes to their services. In time, they will benefit from much improved coordination,” he says.

However, Mental Health Foundation chief executive Andrew McCulloch is not so optimistic that joined up working is the answer.

“This has rarely been the case in the past,” he warns. “And we are concerned that such mergers might lead to the creation of single monolithic providers which could diminish patients’ choice. This is something we will be watching carefully for.”

But Mr Shrubb believes a marriage of community and mental health will boost the profile of mental health services, particularly with GPs who will be taking over commissioning.

“As many of the services are better understood by GPs - health visiting, district nursing - there could be some good spin-offs,” he says. “It may well be that GPs/consortia get a more positive understanding of mental health.”